The Response to Bronchodilators in Adults is not Predictive of Bronchial-hyperreactivity

Fruchter, Oren; Hardak, Emília; Yigla, Mordechai

doi:10.1080/02770900802712989

Cited by 4 publications

(5 citation statements)

References 17 publications

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“…Similarly, we found a significant, albeit weak, correlation between BDR and methacholine PC20. On the contrary, there are other reports that BDR is not related to methacholine responsiveness [10,11]. The reasons for these conflicting data are unclear, but they are presumably due to confounding factors such as airway remodelling.…”

Section: Discussionmentioning

confidence: 95%

“…Indeed, provocation challenges, when contraindicated for reason of severe airway obstruction, have been replaced by bronchodilator tests. However, studies on the relationship between BHR to histamine or methacholine and BDR have yielded conflicting results; some found a significant correlation [7][8][9], whereas others did not [10,11]. Conversely, there is no information as to whether BDR correlates with BHR to indirect stimuli, such as AMP.…”

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confidence: 99%

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Bronchial hyperresponsiveness to methacholine/AMP and the bronchodilator response in asthmatic children

Suh¹,

Lee²,

Kim³

et al. 2010

Eur Respir J

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Bronchodilator response (BDR) is assessed to estimate the reversibility of airflow obstruction. Bronchial hyperresponsiveness (BHR) is a characteristic feature of asthma and is usually measured by means of bronchial challenges using direct or indirect stimuli. The aim of the present study was to compare BHR to methacholine (direct) and that to adenosine 5'-monophosphate (AMP) (indirect) with regard to their relationships to BDR in asthmatic children.Methacholine and AMP challenge tests were performed on 138 children with mild-to-moderate asthma, and the provocative concentration causing a 20% decline in forced expiratory volume in 1 s (FEV1) (PC20) was determined for each challenge. BDR was calculated as the change in FEV1, expressed as a percentage of the initial value, after inhalation of 400 mg salbutamol.Methacholine PC20 correlated significantly but weakly with BDR (r5 -0.254; p50.003). However, there was a significant and strong correlation between AMP PC20 and BDR (r5 -0.489; p50.000). For AMP PC20, the relationship was closer than for methacholine PC20 (p50.024 for comparison between correlation coefficients). The same figures were observed when BDR was expressed as a percentage of the predicted value.A stronger correlation of BDR with AMP PC20 than with methacholine PC20 suggests that BDR may be better reflected by BHR as assessed by AMP challenge than by methacholine challenge.

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Section: Discussionmentioning

confidence: 95%

mentioning

confidence: 99%

Bronchial hyperresponsiveness to methacholine/AMP and the bronchodilator response in asthmatic children

Suh¹,

Lee²,

Kim³

et al. 2010

Eur Respir J

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“…It has long been debated whether BHR correlates simply with BDR because pathologic mechanisms in asthma, such as airway remodeling, are very complicated 22-24. Regardless, BHR and BDR have been accepted to be clinically important, independent indices that represent the pathology of asthma.…”

Section: Discussionmentioning

confidence: 99%

Fractional Exhaled Nitric Oxide and Impulse Oscillometry in Children With Allergic Rhinitis

Kim

Park

Kim

et al. 2014

Allergy Asthma Immunol Res

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PurposeAirway inflammation, bronchial hyper-responsiveness (BHR), and bronchodilator response (BDR) are representative characteristics of asthma. Because allergic rhinitis (AR) is a risk factor for asthma development, we evaluated these 3 characteristics in AR using measurement of fractional exhaled nitric oxide (FeNO), a methacholine challenge test (MCT), and impulse oscillometry (IOS).MethodsThis study included 112 children with asthma (asthma group), 196 children with AR (AR group), and 32 control subjects (control group). We compared pulmonary function parameters and FeNO levels among the 3 groups. The AR group was subdivided into 2 categories: the AR group with BHR and the AR group without, and again pulmonary function and FeNO levels were compared between the 2 subgroups.ResultsFeNO levels were more increased in the AR and asthma groups than in the control group; within the AR group, FeNO was higher in the AR group with BHR than in the AR group without. The BDR was more increased in the AR group than in the control group when percent changes in reactance at 5 Hz (Δ X5) and reactance area (Δ AX) were compared. In the AR group, however, there was no difference in Δ X5 and Δ AX between the AR group with BHR and the AR group without.ConclusionsReversible airway obstruction on IOS and elevated FeNO levels were observed in children with AR. Because elevated FeNO levels can indicate airway inflammation and because chronic inflammation may lead to BHR, FeNO levels may be associated with BHR in AR. IOS can be a useful tool for detecting lower airway involvement of AR independent of BHR assessed in the MCT.

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“…With regard to the principal new finding in this study (ie, that the airway response to inhaled fast-acting b 2 -agonist and EVH challenge did not correlate in a group of adults with asthma), previous work has shown weak concordance between the airway responses to inhaled b 2 -agonist and methacholine responsiveness. 2,17,18 However, whereas methacholine is a direct-acting smooth muscle agonist that acts via binding to muscarinic receptors on airway smooth muscle, EVH causes airway narrowing indirectly through the actions of pro-inflammatory mediators released by resident and nonresident airway cells. 19 Similarly, the amount of bronchoconstriction following exercise (another bronchoprovocation test) did not correlate with bronchodilator responsiveness in a group of 21 adults with asthma in whom both methacholine responsiveness and degree of airway inflammation demonstrated a range of severity.…”

Section: Discussionmentioning

confidence: 99%

Spirometric Response to Bronchodilator and Eucapnic Voluntary Hyperpnea in Adults With Asthma

et al. 2021

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BACKGROUND:The spirometric response to fast-acting bronchodilator is used clinically to diagnose asthma and in clinical research to verify its presence. However, bronchodilator responsiveness does not correlate with airway hyper-responsiveness measured with the direct-acting stimulus of methacholine, demonstrating that bronchodilator responsiveness is a problematic method for diagnosing asthma. The relationship between bronchodilator responsiveness and airway hyper-responsiveness assessed with indirect-acting stimuli is not known. METHODS: Retrospectively, the spirometric responses to inhaled bronchodilator and a eucapnic voluntary hyperpnea challenge (EVH) were compared in 39 non-smoking adult subjects with asthma (26 male, 13 female; mean 6 SD age 26.9 6 7.8 y; mean 6 SD body mass index 26.3 6 4.7 kg/m 2 ). All subjects met one or both of 2 criteria: 6 12% and 200 mL increase in FEV 1 after inhaled bronchodilator, and 6 10% decrease in FEV 1 after an EVH challenge. RESULTS: Overall, FEV 1 increased by 9.9 6 7.9% after bronchodilator (3.93 6 0.97 to 4.28 6 0.91 L, P < .001) and decreased by 23.9 6 15.0% after the EVH challenge (3.89 6 0.89 to 2.96 6 0.88 L, P < .001). However, the change in FEV 1 after bronchodilator did not correlate with the change after EVH challenge (r 5 0.062, P 5 .71). Significant bronchodilator responsiveness predicted a positive response to EVH challenge in 9 of 33 subjects (sensitivity 27%). Following EVH, the change in FEV 1 strongly correlated with the change in FVC (FEV 1 percent change vs FVC percent change, r 5 0.831, P < .001; FEV 1 DL vs FVC DL, r 5 0.799, P < .001). CONCLUSIONS: These results extend previous findings that demonstrate a lack of association between bronchodilator responsiveness and methacholine responsiveness. Given the poor concordance between the spirometric response to fast-acting bronchodilator and the EVH challenge, these findings suggest that the airway response to inhaled b 2 -agonist must be interpreted with caution and in the context of its determinants and limitations.

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The Response to Bronchodilators in Adults is not Predictive of Bronchial-hyperreactivity

Abstract: In adults with suspected asthma who have normal spirometry, the response to BD cannot be used to predict BHR.

Cited by 4 publications

References 17 publications

Bronchial hyperresponsiveness to methacholine/AMP and the bronchodilator response in asthmatic children

Bronchial hyperresponsiveness to methacholine/AMP and the bronchodilator response in asthmatic children

Fractional Exhaled Nitric Oxide and Impulse Oscillometry in Children With Allergic Rhinitis

Spirometric Response to Bronchodilator and Eucapnic Voluntary Hyperpnea in Adults With Asthma

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